Background: Excessive working hours and fatigue in medical training are a source of concern. Practitioner fatigue manifests itself in both risks to the patient and the medical trainee. This study aimed to quantify the effect of shift work on multiple cognitive function domains in anaesthesiology trainees at Tygerberg Academic Hospital. Secondary outcomes were to identify strategies to ameliorate shift work-related fatigue.
Methods: An analytical observational study was conducted using mixed methods. The participants, anaesthesiology registrars and medical officers, completed an electronic cognitive test battery consisting of four tests, and a paper-based questionnaire prior to and following a 14-hour night shift.
Results: Twenty-nine participants engaged in the study; including 14 males and 15 females with an age range 29–58 years. The study demonstrated a statistically significant impairment in reaction time in two of the four cognitive domains tested, ranging from 13.4–17.8%. No statistically significant change in accuracy was seen in any of the cognitive tests. A subjective increase in fatigue was also demonstrated using the Karolinska Sleepiness Scale. Further, no statistically significant correlation was found between the decline in reaction time and the individual and work-related factors which were assessed in the paper-based questionnaires.
Conclusion: Fatigue in anaesthesiology trainees after a 14-hour night shift results in a decline in reaction time in the cognitive domains of psychomotor function and attention. Accuracy, however, remained unchanged. The study was unable to identify strategies which ameliorated these effects with statistical significance. Nevertheless, the recommendations and guidelines of various anaesthesiology bodies, including the South African Society of Anaesthesiologists, are supported. Further studies using a larger and more diverse study population are suggested.
Focal variations in retinal vascularization of OIR mice correlate with thickness and function. Adult OIR mice had increased retinal artery tortuosity, prolonged b-wave peak time, and decreased retinal vein width with inner retina attrition. These suggest abnormalities in inner retinal morphology or post-receptor signaling. Studying interactions between retinal vascular, structural, and functional changes could enhance knowledge of OIR pathogenesis and potential therapies.
Background. In South Africa, in babies >2 500 g, intrapartum asphyxia is the main cause of neonatal death or stillbirth in those who were alive prior to labour. In a developing population, ~60% of neonatal encephalopathy (NE) has evidence of intrapartum hypoxic ischaemia. Therapeutic hypothermia for term babies born with NE can improve neonatal prognosis and long-term survival.
Objectives. To identify the healthcare worker- and system-related modifiable factor(s) that were associated with NE in babies of ≥36 weeks’ gestation born at Tygerberg Hospital (a secondary/tertiary referral hospital) between 1 January 2016 and 30 December 2018.
Methods. This was an observational cross-sectional study analysing data from the Tygerberg Hospital Hypoxic Ischaemic Encephalopathy database, the electronic labour ward register, the mortality database and clinical data from patient folders.
Results. A total of 118 babies were admitted for head cooling, and therefore included in the study. The hospital in-born rate for serious encephalopathy is 5.5/1 000 in singleton live-born babies (9/1 000 rate for live-born deliveries ≥36 weeks). A sentinel event was identified in 19 (16%) cases. Delay in accessing theatre was the main system-related modifiable factor (25/58 or 43% of cases delivered by emergency caesarean delivery). The average decision-to-incision time was 1 hour 40 minutes, while the average bed occupancy in the emergency maternity centre was 102%. Failure to recognise or respond to an abnormal cardiotocograph was the dominant avoidable factor related to healthcare workers in 34 cases (36.4%).
Conclusion. Babies born with severe NE place a burden on parents, healthcare staff and resources. Careful intrapartum care, including utilisation of protocols for the use of oxytocin, are imperative. It is recommended that improved access to emergency theatres and appropriately trained staff for maternity units should be a priority for healthcare planners.
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